Acute Olympic Hepatitis: A Medical Experience from the Vancouver 2010 Games

ABSTRACT
A 50-year-old Chinese man, visiting for the Vancouver 2010 Winter Olympic Games Opening Ceremonies, was referred with acute onset hepatitis. On presentation, he was found deeply jaundiced but without any clinical encephalopathy or stigmata of chronic liver disease. Initial laboratory investigations revealed acute liver failure that was complicated by renal impairment. His immediate prognosis was considered significant enough to result in referral to the liver transplant service. With increasing global travel, it is apparent that acute hepatitis E should be considered in the differential diagnosis of any patient with acute liver failure. Appropriate screening tests in this patient included hepatitis A, B and C viral serology and metabolic and autoimmune markers. The initial history suggested hepatotoxicity from traditional Chinese medicines; however, after a careful review via an interpreter, it was clear that the herbal medications were consumed after the patient became ill. Liver biopsy revealed features consistent with acute hepatitis E, which was confirmed by subsequent positive viral serology for the hepatitis E virus (HEV), particularly anti-HEV IgM. The patient’s liver function improved with conservative treatment, and he was able to return home.